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White, Orin Louis Jr.
11.1afiti. NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Orin Louis White Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 08/31/2023 92 Years War or Dates F.. Place of Death Hospital,Institution or WCity,Town or Village Granville Town Street Address 8642 State Route 40, Granville Town, New York 12832 O Manner of Death ❑^ Natural Cause Accident 0 Homicide Duicide El Undetermined I El Pending VCircumstances 1 IInvestigation CI Medical Certifier Name Title Sarah Hyland NP Address 79 North St,Granville,New York 12832 Death Certificate Filed Town Of Granville District Number Register Number • City,Town or Village 5756 48 Burial Date Cemetery,Crematory or Facility Name 09/05/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York IIIDonation o❑Removal Date Place Removed and/or and/or Held F— Hold Address N 0 n- Date Point of N❑Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom E— Remains are Shipped,If Other than Above N Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/05/2023 Registrar of Vital Statistics Jenny Linda M Martelle(Electronically Signed) (signature) District Number 5756 Place Town Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 4__l_ ' Z Date of Disposition `A (73 Place of Disposition + ;� 2 (address W Cl) Q (section) t number) (grave number) 0 Name of Sexton or Person in Char f Premises /' l �rt Z (pleas print) IJJ Signature Title II lmr� 7 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#